OP0300 5-YEAR TRAJECTORIES OF URATE-LOWERING THERAPY AND IMPACT OF COLCHICINE ON CARDIOVASCULAR RISK: REAL-LIFE DATA ON 70,000+ PATIENTS
Authors: A. Latourte, A. Bellamine, R. Sigogne, H. K. Ea, T. Bardin, M. Maravic, P. Richette
Journal: Annals of the Rheumatic Diseases (2022)

Background Urate-lowering therapy (ULT; allopurinol: ALLO and febuxostat: FBX) are recommended to treat gout on the long term, but gout management is often suboptimal. Colchicine can reduce the rate of gout flares upon ULT initiation, and several randomized clinical trials suggest that this drug is also associated with a decreased risk of cardiovascular events. Objectives The objectives of this study were to analyze in a real-life setting 1) ULT trajectories and maintenance following initiation and 2) the long-term impact of co-prescribing colchicine on the cardiovascular (CV) risk. Methods The LRx database contains the dispensing data of nearly 45% of French pharmacies. Patients who initiated ULT in 2016 (no dispensing in the previous year) and who received regular dispensing (any drug/device) from the LRx pharmacy network until the end of 2020 were included. A multivariate Cox model investigated the factors associated with ULT maintenance over time. In the same cohort, the maintenance of ULT was compared with that of other treatments for chronic diseases. The therapeutic trajectory (continuation, change of dose or type of ULT, discontinuation) was also evaluated. The impact of co-prescribing colchicine on CV risk was studied in the subgroup of patients over 50 years of age without previous delivery of CV treatment (antidiabetics, antiaggregants, antihypertensives, diuretics, statins) in the year prior to ULT initiation. The incidence of CV treatments prescription (≥ 2 deliveries) was compared between patients who initiated ULT with or without colchicine) and those treated with colchicine without ULT using logistic regression. Results In 2016, 74,665 patients (mean age ± SD: 70 ± 13 years, 64% men) had initiated ULT, mainly in primary care by a general practitioner (GP) (77%). ALLO was initiated in 68% of patients (100mg/d: 56%, 200mg/d: 32%, 300mg/d: 8%); FBX in 32% (80mg/d: 85%). Colchicine was co-prescribed in 34% of patients. Factors associated with better ULT maintenance were male sex, age &lt; 70, initial prescription by a GP, and co-prescription of colchicine. Conversely, initiation in a hospital setting was associated with poorer ULT maintenance (all p&lt;0.0000001). Half of the patients had stopped ULT after 316 days. This time was shorter than that observed in the same population with anti-diabetics (894 days), ACE inhibitors/sartans (725 days), antiaggregants (718 days). A change in the dose or type of ULT was observed in only a minority of patients. The daily dose of colchicine was associated with a lower risk of initiating a CV treatment (OR per quartile: 0.93 [0.91; 0.96], regardless of co-prescribing with ULT, suggesting a CV benefit of colchicine. Conclusion This study illustrates that gout management with ULT remains largely suboptimal in France, especially in comparison with other chronic conditions. In addition, our results suggests that flare prophylaxis with colchicine might lower CV risk in gout patients. Disclosure of Interests None declared